If the flu vaccine shortage
leads to a significant surge in flu patients, maintaining optimal staff health
will be critical to providing adequate care for those patients, observers agree.
Not only would absenteeism be a problem, but "presenteeism" — defined by occupational
health experts as those times when sick workers are on the job, but performing
below their normal abilities — also could impact care. Accordingly, the wise
ED manager will taking steps to optimize staff health.

"ED staff serve as an important
source of care and contact for patients coming in and out, and as they become
ill and unable to work, the staffing in the ED becomes decreased, ED waits become
longer, and that ultimately impacts the health and treatment of patients," says
Katherine West, BSN, MSED, CIC, infection control consultant with Infection
Control/Emerging Concepts, a Manassas, VA-based infection control and education
consulting company. West, a former ED nurse, is the author of Infection Control
in the Emergency Department (Rockville, MD: Aspen Publishers; 1988).

If your staff have not
been inoculated, that should be your first step, she notes. "The ED staff are
in the high-risk group for flu and are to be receiving flu vaccine this year,"
explains West, adding that this group should include triage staff and those
providing "hands-on patient care" as defined by the CDC. (The definition includes
being close enough to reach out and touch a patient three times a day. The complete
guidelines are available at www.cdc.gov/flu.)
"Paramedics also fall into that group," she adds. If there are not enough injections
available, West recommends using FluMist (MedImmune Vaccines, Gaithersburg,
MD).

"There were concerns last
year that the live virus would pose a potential risk to patients, but that has
been reevaluated. For health care workers up to age 49, it is recommended this
year, and there are 3 million doses available." Anyone who takes it, however,
should not care for severely immunocompromised patients for seven days, she
continues.

Mike Parry, MD,
director of infectious diseases at Stamford (CT) Hospital and professor of clinical
medicine at Columbia University in New York City, has adopted a similar approach.
"We’re vaccinating all those giving direct care using the CDC definition, and
we’ve probably done 50% of the total staff and 75% of direct caregivers," he
reports. "We bought FluMist to immunize the rest of the staff who agree to be
immunized — even the registrars in contact with patients, so everyone has been
offered it." However, Parry only obtains about 60% compliance "on a good year,"
because some staff believes it will make them sick, he concedes.

Despite such challenges,
"The ED is a place where you really need to achieve as close to 100% vaccination
as you can," West advises. "They’re vulnerable because they are on the front
line and see patients before they know what they’ve got."

In terms of other strategies
to protect the health of ED staff, "Most of the hospitals in the country have
adopted the [CDC’s] Universal Respiratory Etiquette," Parry says.

He says his staff will
encourage patients who come into the ED to be careful about how they cough or
sneeze, by covering their nose and mouth. "We have a big display in our ED where
we have masks and gloves and tissues and hand-cleaning material, so people can
wash with an alcohol sanitizer, get tissues to use, and masks and gloves to
wear," Parry explains.

ED managers face a dilemma
when staff are ill but want to work: If they come in, they can infect others,
but if they stay home, the ED could be badly understaffed.

"We don’t have a definite
policy of excluding people from work who are ill with upper-respiratory system
diseases," Parry explains. "But if someone comes to employee health and tests
positive for influenza, we will take them off work."

West has a more definitive
approach. "Don’t come to work when you’re sick," she warns, noting that CDC’s
work restriction guidelines recommend this method. "You’ll have co-workers getting
sick, and you may compromise patients who are ill. That’s the reason vaccination
is so important in the ED."

Lurking in the background
is an underlying concern about the Fujian strain of flu, West adds.

"We are seeing the first
human cases of Avian flu (in Thailand and Vietnam), and there is fear in the
medical community that an animal or person will get infected with Fujian and
get infected by Avian, they’ll merge and form a new strain against which we
will not be able protect or treat, and this will be a new pandemic."

Vaccination, she notes,
will minimize the chances that ED staff could be potential carriers.

Sources

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